Prevalence of tick-borne encephalitis virus in questing Ixodes ricinus nymphs in southern Scandinavia and the possible influence of meteorological factors.

Ixodes ricinus ticks are Scandinavia's main vector for tick-borne encephalitis virus (TBEV), which infects many people annually. The aims of the present study were (i) to obtain information on the TBEV prevalence in host-seeking I. ricinus collected within the Øresund-Kattegat-Skagerrak (ØKS) region, which lies in southern Norway, southern Sweden and Denmark; (ii) to analyse whether there are potential spatial patterns in the TBEV prevalence; and (iii) to understand the relationship between TBEV prevalence and meteorological factors in southern Scandinavia. Tick nymphs were collected in 2016, in southern Scandinavia, and screened for TBEV, using pools of 10 nymphs, with RT real-time PCR, and positive samples were confirmed with pyrosequencing. Spatial autocorrelation and cluster analysis was performed with Global Moran's I and SatScan to test for spatial patterns and potential local clusters of the TBEV pool prevalence at each of the 50 sites. A climatic analysis was made to correlate parameters such as minimum, mean and maximum temperature, relative humidity and saturation deficit with TBEV pool prevalence. The climatic data were acquired from the nearest meteorological stations for 2015 and 2016. This study confirms the presence of TBEV in 12 out of 30 locations in Denmark, where six were from Jutland, three from Zealand and two from Bornholm and Falster counties. In total, five out of nine sites were positive from southern Sweden. TBEV prevalence of 0.7%, 0.5% and 0.5%, in nymphs, was found at three sites along the Oslofjord (two sites) and northern Skåne region (one site), indicating a potential concern for public health. We report an overall estimated TBEV prevalence of 0.1% in questing I. ricinus nymphs in southern Scandinavia with a region-specific prevalence of 0.1% in Denmark, 0.2% in southern Sweden and 0.1% in southeastern Norway. No evidence of a spatial pattern or local clusters was found in the study region. We found a strong correlation between TBEV prevalence in ticks and relative humidity in Sweden and Norway, which might suggest that humidity has a role in maintaining TBEV prevalence in ticks. TBEV is an emerging tick-borne pathogen in southern Scandinavia, and we recommend further studies to understand the TBEV transmission potential with changing climate in Scandinavia.

Two thirds of the most disadvantaged Dalit population of Nepal still do not deliver in health facilities despite impressive success in maternal health.

INTRODUCTION: The gains in maternal and child health in Nepal was impressive in the last two decade but success was unevenly distributed. The Dalits of Nepal are the most disadvantaged caste group and have benefitted least from the advances in maternal health service. This study investigated the rate of and factors associated with the institutional delivery among the Dalit women of the Mahottari, Nepal. MATERIALS AND METHODS: A cross-sectional study was conducted during July-December 2014 using a structured questionnaire. A total of 328 mothers who had their childbirth within one year were interviewed. Descriptive statistics followed by binary and multivariable logistic regression analyses were computed to find the association of key variables with institutional delivery. RESULTS: In this study, only 30% of the mother had institutional delivery. Fifty eight percent mothers had no any birth preparedness and complication readiness. Four or more antenatal visits (Adjusted Odds Ratio (AOR): 3.54, CI: 1.82-6.90), birth preparedness (AOR: 3.15, CI: 1.61-6.18), planned pregnancy (AOR: 2.63, CI: 1.37-5.06) and receiving advice from health staffs (AOR: 3.96, CI: 2.00-7.86) and mother's autonomy (AOR: 2.25, CI: 1.03-4.49) were associated with child birth at the health facility. CONCLUSION: This study indicated that birth preparedness, ANC visit frequency, planning of pregnancy, advice for institutional delivery and mother's autonomy were significantly associated with health facility delivery. Less than one-third mothers had institutional delivery and reasons were feeling of un-necessary, far distance, lack of transportation and associated cost; and birth preparedness is also low. Hence, promotion of birth preparedness, uptake of ANC service, proper counselling for institutional delivery, promoting women autonomy and strengthening women to have planned pregnancy were some recommendation to promote institutional delivery for such disadvantage community.